From: Foreign Patients Visiting the Emergency Department: A Systematic Review of Studies in Japan
| Author | Year | Study duration | Study type | Location | Definition of “foreigners” | Population | |
|---|---|---|---|---|---|---|---|
| 24 | Takashina et al. | 2017 | January 2011―December 2015 | Retrospective review of medical records and accounting data | Kyoto | definition of “visitors” Provided | “Visitors” that visited or were referred to the emergency department |
| 25 | Taguchi et al | 2018 | April 2012―March 2016 | Retrospective review of medical records | Hokkaido | Not provided | Foreign patients |
| 26 | Oshita et al | 2019 | April 2015―March 2018 | Retrospective review of medical records | Yamanashi | Not provided | Foreign visitors |
| 27 | Kainuma et al | 2019 | April 2014―March 2019 | Retrospective review of medical records | Osaka | Not provided | Foreign patients |
| 28 | Suzaki et al. | 2019 | April―September 2017 | Retrospective review of medical records | Tokyo | Not provided | Foreign patients visiting the primary and secondary emergency department for the first time |
| 29 | Nakazawa et al. | 2020 | January 2014―December 2018 | Retrospective review of medical records | Okinawa | Not provided | Pregnant foreign patients in a single emergency department |
| 30 | Shimoyama et al. | 2020 | April 2015―March 2018 | Retrospective review of medical records | Tokyo | Not provided | Foreign patients transported to a tertiary care center |
| 31 | Aoki et al. | 2022 | April 2018―March 2020 | Retrospective review of medical records | Nagano | Not provided | Foreign patients transported to a tertiary care center |
| 32 | Ishii et al. | 2022 | January 2010―December 2019 | Retrospective review of medical records | Tokyo | Visual classification of patient names | Foreign patients transported to a tertiary care center |
From: Foreign Patients Visiting the Emergency Department: A Systematic Review of Studies in Japan
| Author | Year | Outcome | Transportation | Visits | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Total patients | |||||||||||
| (included in the study) | Hospitalized | Deaths | Walk-in | Ambulance | Air transport | During daytime | During evenings | During nights | |||
| 24 | Takashina et al. | 2017 | 1059 | 46 (4%) | 1 (0%) | 744 (70%) | 314 (30%) | 0 | - | - | - |
| 25 | Taguchi et al | 2018 | 132 | - | - | - | 132 (100%) | - | 53 (40%) | 49 (37%) | 30 (33%) |
| 26 | Oshita et al | 2019 | 474 | - | 1 (0%) | 380 (80%) | 93 (20%) | 1 | 205 (43%) | 269 (57%) | - |
| 27 | Kainuma et al | 2019 | 198 | 13 (7%) | 3 (2%) | 56 (28%) | 142 (72%) | 0 | 142 (71%) | 56 (29%) | |
| 28 | Suzaki et al. | 2019 | 158 | 3 (2%) | 0 | 131 (83%) | 27 (17%) | 0 | 110 (70%) | 48 (30%) | |
| 29 | Nakazawa et al. | 2020 | 37 | 4 (11%) | 0 | - | - | - | 15 (41%) | 11 (30%) | 11 (30%) |
| 30 | Shimoyama et al. | 2020 | 87 | 55 (63%) | 25 (29%) | - | - | - | - | - | - |
| 31 | Aoki et al. | 2022 | 777 | 71 (9%) | 1 (0%) | 660 (85%) | 106 (14%) | 11 (1.4%) | 405 (52%) | 262 (34%) | 110 (14.2%) |
| 32 | Ishii et al. | 2022 | 325 | - | 27 (8.3%) | - | - | - | - | - | - |
From: Foreign Patients Visiting the Emergency Department: A Systematic Review of Studies in Japan
| Author | Year | Nationality | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Asia | Europe | Oceania | North America | Latin America | Others | Unknown | |||
| 24 | Takashina et al. | 2017 | 477 (45%) | 201 (19%) | 85 (8%) | 148 (14%) | 0 | 169 | 0 |
| 25 | Taguchi et al | 2018 | 84 (64%) | 3 (2%) | - | - | - | 0 | 25 |
| 26 | Oshita et al | 2019 | 369 (78%) | 42 (9%) | 24 (5%) | 34 (7%) | 1 (2%) | 0 | 4 |
| 27 | Kainuma et al | 2019 | 157 (79%) | 23 (12%) | 11 (6%) | 6 (3%) | 0 | 1 | 0 |
| 28 | Suzaki et al. | 2019 | 123 (78%) | 8 (5%) | 0 | 12 (8%) | 0 | 15 | 0 |
| 29 | Nakazawa et al. | 2020 | 32 (86%) | 0 | 2 (5%) | 2 (3%) | 1 (3%) | 0 | 0 |
| 30 | Shimoyama et al. | 2020 | 51 (74%) | 6 (9%) | 4 (6%) | 5 (7%) | 0 | 7 | 18 |
| 31 | Aoki et al. | 2022 | - | - | - | - | - | - | - |
| 32 | Ishii et al. | 2022 | - | - | - | - | - | - | - |
From: Foreign Patients Visiting the Emergency Department: A Systematic Review of Studies in Japan
| Author | Year | Disease | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Infectious | Others/ | |||||||||||||
| Injury | Urology | OBGYN | Pediatrics | Neurology | GI | Cardiovascular | Respiratory | ENT | diseases | Toxicology | unspecified | |||
| 24 | Takashina et al. | 2017 | 295 (28%) | 106 (10%) | 21 (2%) | - | 21 (2%) | 164 (16%) | 32 (3%) | 202 (20%) | 32 (3%) | 169 | ||
| 25 | Taguchi et al | 2018 | 46 (35%) | 5 (4%) | - | - | - | 26 (20%) | - | 11 (8%) | - | - | 12 (9%) | 32 |
| 26 | Oshita et al | 2019 | 166 (35%) | 22 (5%) | 21 (4%) | 64 (14%) | 168 (35%) | - | - | - | - | - | - | 33 |
| 27 | Kainuma et al | 2019 | 72(36%) | 5 (2%) | - | - | 15(8%) | 32(16%) | 21(11%) | 8(4%) | 14 (7%) | - | - | 31 |
| 28 | Suzaki et al. | 2019 | 19 (12%) | 4 (3%) | 0 | 0 | 4 (3%) | 21 (13%) | 2 (1%) | 3 (2%) | 3 (2%) | 37 (23%) | 92 | |
| 29 | Nakazawa et al. | 2020 | - | - | 37 (100%) | - | - | - | - | - | - | - | - | - |
| 30 | Shimoyama et al. | 2020 | 16 (18%) | 4 (5%) | 37 (31%) | 3 (4%) | 12 (14%) | 24 | ||||||
| 31 | Aoki et al. | 2022 | 263 (33.9%) | 47 (6.0%) | - | - | - | 52 (67%) | - | 114 (14.7%) | - | 65 (8.4%) | - | 56 |
| 32 | Ishii et al. | 2022 | 73 (21.8%) | 0 | - | - | 14 (4.3%) | 56 (17.2%) | 73 (22.4%) | 16 (4.9%) | - | 17 (5.2%) | 28 (8.6%) | 48 |
From: Foreign Patients Visiting the Emergency Department: A Systematic Review of Studies in Japan
| # | Author | Year | Payment | Key findings | |
|---|---|---|---|---|---|
| Outstanding | |||||
| Fee (JPY) | expenses | ||||
| 24 | Takashina et al. | 68,000/outpatient, | |||
| 745,000/inpatient, | Children accounted for 19.3% of the patients. | ||||
| 2017 | 174500/day/person | 1% of total | Many emergency transports were mild cases, and hospitalization was short at the average of 9.7 days. | ||
| 25 | Taguchi et al | 2018 | - | - | Cultural differences, linguistics, and religions posed as problems when dealing with foreign patients. |
| Dealing with foreign patients requires a comprehensive approach with medical and non-medical staff. | |||||
| 26 | Oshita et al | 2019 | - | - | There are differences in the needs of foreign patients between each location. |
| Whether patients understand translational devices are unknown. | |||||
| Some required hospitalizations but refused; whether this is due to linguistic problems remains difficult to evaluate. | |||||
| Passport documentations and death certificates for other countries posed as difficulties. | |||||
| 27 | Kainuma et al | 2019 | 108,000 ± 453,340 | 6 (3%) | Communication was mainly possible with the usage of interpreting device. |
| Unpaid medical expenses became a problem although many tourists had travel insurance. | |||||
| 28 | Suzaki et al. | 2019 | - | 3 (2%) | Infectious diseases, which were of common diseases, were also common among foreign patients. |
| Primary and secondary emergency departments also had a high number of injuries. | |||||
| Some cases included several refusals of other medical facilities. | |||||
| Eight percent of patients with residency in Japan did not have a national healthcare insurance. | |||||
| 29 | Nakazawa et al. | 2020 | - | - | Difficulty was found in retrieving information on the gynecological status of patients from other countries. |
| Arrival in ambulances was common among foreign patients than Japanese patients. | |||||
| 30 | Shimoyama et al. | 2020 | 1,0009,735/case | 13 (15%) | Forty-two percent of the patients were covered with a Japanese public healthcare insurance. |
| Fifty-four percent of the cases required linguistic assistance, but professional interpreting was provided in only one case. | |||||
| Difficulty was found in gaining informed consent and planning international transfers. | |||||
| 31 | Aoki et al. | 2022 | - | - | Language used when treating the patients was associated with length of stay in the emergency department. |
| 32 | Ishii et al. | 2022 | - | - | Anaphylaxis, burn, and infectious disease diagnoses were more common among non-Japanese patients. |
| No statistical significance was found in mortality rates or mean lengths of stay with stratification on language or disorientation of the CNS. |
From: Foreign Patients Visiting the Emergency Department: A Systematic Review of Studies in Japan
| # | Author | Year | Duration | Study type | Location | Population | Definition of “foreigners” | Outcome | Key findings |
|---|---|---|---|---|---|---|---|---|---|
| 33 | Katayama et al | 2016 | Jan–Dec 2013 | Retrospective study of EMS records | Osaka City | Patients using ambulances in Osaka City | Not defined | Characteristics of patients who experienced difficulty in hospital acceptance at the scene by emergency medical service personnel | Being a foreign patient was associated with difficulty in hospital acceptance at scene |
| Difficulty may have occurred due to lack of multilingual staff in hospitals of Osaka | |||||||||
| 34 | Kishi et al. | 2018 | Jan 10–July 31, 2018 | Survey | Osaka Pref. | Hospitals with emergency departments in Osaka Prefecture | Not defined | Concerns when treating a foreign patient | Seventy-one percent of the facilities had difficulty as they had no interpreter. Thirty-eight percent of the hospitals experienced outstanding accounts. |
| 35 | Kishi et al. | 2020 | Jan 10–Dec 28, 2018 | Survey | Osaka Pref. | Hospitals with emergency departments in Osaka Prefecture | Not defined | Concerns when treating a foreign patient | Seventy-two percent of the facilities had difficulty as they had no interpreter. Thirty-six percent of the hospitals experienced outstanding accounts. Issues regarding the patients’ perception toward medicine, religion, diet, and patient transfers arose as new problems in hospitals. |
| 36 | Beppu et al. | 2020 | 2017.7–2018.1 | Interview | Tokyo | Foreign patients over 20 years old that did not speak Japanese in an emergency department | Not provided | Pain, cultural difficulties, communication difficulties, worries on reoccurrence of the symptoms, and worries on payment were noted as difficulties. | Physical difficulties are more critical in emergency departments compared to the Japanese. Difficulties change during the clinical course. |
